Overlap of Delivery During Transition From Insulin Pump to Injections Offers Better Glycemic Control in Type 1 Diabetes

Among adults with type 1 diabetes, overlapping insulin delivery methods when transitioning from an insulin pump to multiple daily injections of insulin degludec offered better glycemic control than abrupt discontinuation of the insulin pump and initiation of injections, according to study results presented at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).

Investigators of this single-center, open-label, randomized controlled trial sought to evaluate methods guiding a successful transition from an insulin pump to multiple daily injections of insulin degludec in 30 patients with type 1 diabetes. All participants had used an insulin pump for more than 6 months and had glycated hemoglobin levels between 6.5% and 8.5%. Participants were randomly assigned to the standard-of-care method (n=17) or overlap transition method (n=13) when switching from an insulin pump to multiple daily injections.

The standard-of-care group stopped insulin pump use and started insulin degludec using a 1:1 dose conversion; the overlap group started insulin degludec using a 1:1 dose conversion at the pump basal dose while continuing the insulin pump for the first 48 hours with gradual basal reduction (50% on day 1, 75% on day 2, then stopped). The study endpoint was glucose percentage of time in range (70-180 mg/dL), below range (<70 mg/dL), and above range (>180 mg/dL) in the first 72 hours of transition as determined by continuous glucose monitoring (CGM).

Comparing baseline CGM-based metrics, the overlap group spent more time in range vs the standard-of-care group (61.3% [interquartile range (IQR) 46.7-70.8] vs 57.3% [IQR 39.7-60.5]; P =.19), and less time above (31.7% [IQR 26.1-52.7] vs 40.7% [IQR 31.2-56.1]; P =.41) or below range (2.2% [IQR 1.4-9.5] vs 4.8% [IQR 1.5-11.5]; P =.46). Furthermore, the overlap group required fewer correction boluses compared with the standard-of-care group (mean 4.0 correction boluses/d [IQR 3.0-6.5] vs mean 6.5 correction boluses/d [IQR 4.5-8.7]; P =.20). Neither group reported treatment-related adverse events, and both methods of transition were considered safe.

Limitations of the study include the single-center design, small sample size, and exploratory nature of the analysis.

The researchers concluded that when transitioning from an insulin pump to multiple daily injections, the overlap of insulin degludec and an insulin pump for the first 48 hours may result in better glycemic control compared with immediate discontinuation of the insulin pump and starting injections.

Reference

Shah VN, Akturk HK, Joseph H, Schneider N, Snell-Bergeon JK. Transition from insulin pump to multiple daily injections using insulin degludec in adults with type 1 diabetes: a randomized controlled trial. Presented at: 2021 AACE Virtual Annual Meeting, May 26-29, 2021.